Tar Springs Home Care

Type of visit: Case Management - Incident

On 07/06/26, Licensing Program Analyst (LPA) M. Yang conducted case management incident visit to the facility. LPA introduced self, stated the purpose of the visit, and met with Licensee/Administrator Socorro Ann Telmo. The purpose of the visit is to conduct a health and safety visit on the resident in care and follow up on written incident report that was reported to the department where staff observed R1’s right ankle and left knee swelling with no prior fall incident. Interviews were conducted and records were received. The information provided will be reviewed; a follow up case management will be conducted if necessary for the incident report. During tour of facility, R1 was observed laying in bed using full rails. A deficiency is being cited, per California Code of Regulations, Title 22, Division 6, see attached Lic 809D. An exit interview was conducted. A copy of this report and appeal rights were provided to Licensee, whose signature confirms receipt of this report.the state’s words, verbatim · CDSS document, Jul 6, 2026

From the deficiency page — Deficiency type: Type B · Section cited: CCR 87608(a)(5)(B) · Plan of correction due date: Jul 7, 2026

87608(a)(5)(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement is not met as evidenced by: Based on observation and reviewed records, R1 is currently not on hospice care and using a hospital bed with full rails, which poses/posed a potential health and safety and personal rights risk to the resident in care.the state’s words, verbatim · CDSS document, Jul 6, 2026

Plan of correction: R1 has doctor’s order for half rail bed. Staff removed full bed rails during visit and replaced with half bed rails. POC cleared during visit.

Type of visit: Required - 1 Year

On 05/28/26, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and met with Licensee/ Administrator (L1) Socorro Ann Telmo. LPA toured facility with L1. All six residents were present during the inspection. Residents were observed sitting in the living room and the bedrooms. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Fire extinguisher was observed with purchased date of 01/26/26. Washer and dryer observed operating during visit. Chemicals observed locked under kitchen sink, garage cabinet, and bathroom sinks. Knives stored and locked in kitchen drawer. Medications observed stored and locked under kitchen counter. A medication bottle was observed unlocked on kitchen counter. LPA observed 2-day perishable food was observed and 7 day non-perishable food. Freezer temperature maintained at 0 degree F and refrigerator temperature maintained at 40 degrees F. Extra linens and towels were observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mats. Hot water temperature was tested at 108.1 in bathroom 1, 108.1 degrees F in master bedroom bathroom, and 106.7 degrees in 2nd bathroom. Shovels and tree trimmer and lopper trimmer tool were observed unlock in the garage. Outside of facility toured and observed free of debris. Adequate outdoor seating was observed available for the residents. Carbon monoxide and smoke detector operational during visit. A sample of staff and all residents’ files were reviewed. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA received copies of: Lic 308, Lic 500, Lic 610E. The requested current liability insurance is to be submitted to the department by 06/03/26. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, May 28, 2026

Type of visit: Required - 1 Year

On 04/29/25, Licensing Program Analyst (LPA) M. Yang arrived unannounced to conduct an Annual Inspection. LPA introduced self, stated the purpose of the visit, and met with Licensee/ Administrator (L1) Socorro Ann Telmo. LPA toured facility with L1. All five residents were present during the inspection. The facility was observed to be at a comfortable temperature, clean, in good repair, and no passageway obstructions or fire hazards were observed inside. Washer observed operating during visit. Chemicals observed locked under kitchen sink and garage cabinet. Knives stored and locked in kitchen drawer. Medications observed stored and locked under kitchen counter. Residents’ MARS and Centrally Stored Medication Records were reviewed. Medications were checked. Fire extinguisher was observed with purchased date of 03/01/25. LPA observed 2-day perishable food was observed and 7 day non-perishable food. Freezer temperature maintained at 0 degree F and refrigerator temperature maintained at 32 degrees F. Extra linens were observed. Residents' bedrooms were toured and observed to be adequately furnished with bed, dresser, and adequate lighting. All bathrooms are observed with securely fastened grab bars and non-skid mat. Hot water temperature was tested at 110.7 and 110.1 degrees F in master bedroom bathroom and 107.4 degrees in hall bathroom. Outside of facility toured and observed free of debris. Adequate outdoor seatings observed available for the residents. A sample of staff and all residents’ files were reviewed. Carbon monoxide and smoke detector operational during visit. A deficiency is being cited on the attached 809D in accordance to California Code of Regulations, Title 22, Division 6. Exit Interview conducted. LPA received copies of: Lic 308, Lic 500, Lic 610E, current Administrator certificate, and current liability insurance. A copy of this report and appeal rights was provided to Licensee, whose signature on this form confirms receipt of this report.the state’s words, verbatim · CDSS document, Apr 29, 2025

Allegation investigated: Due to abuse, resident received an injury

Licensing Program Analysts (LPA) Shawna Doucette arrived at the facility unannounced to commence a complaint investigation and deliver findings. LPA identified herself and explained the purpose of the visit with Staff Beatriz Ancheta. Administrator Socorro Telmo responded to the facility to assist with the visit. LPA reviewed records and interviewed staff. Based on interviews, LPA was unable to determine whether or not R1, received a bruise due to abuse. Based on Hospice records review, R1 bruises easily due to a medication R1 is currently taking. Although the allegation may have happened or is valid, there is not a preponderance of evidence to prove the alleged violation did or did not occur, therefore the allegation is UNSUBSTANTIATED. A copy of this report was provided to Administrator via email. Unsubstantiatedthe state’s words, verbatim · CDSS document, Jun 13, 2024 · control 24-AS-20240314113726

Type of visit: Required - 1 Year

Licensing Program Analysts (LPAs) Shawna Doucette and Brianna Miranda arrived at the facility unannounced to conduct the Required Annual Inspection. LPA disclosed the purpose of the visit and was granted entry into the facility by Staff Beatriz Ancheta. Administrator Socorro Telmo responded to assist with the visit. When LPAs arrived staff struggled with unlocking and opening the door. When LPAs entered the facility a separate lock was observed on the front door. LPA asked Administrator why there was a separate lock. Administrator stated they had a resident that wandered and it was to keep the resident in. When LPAs entered the facility there was a smell of urine. Facility had delay egress turned off for the front and garage door. The back door did not have a delay egress. LPA took photos. A tour of the facility was conducted with Staff. LPA Doucette observed 6 bedrooms in the facility. While touring the facility, Hot water temperature was measured 106.9 F. Facility is at 76 F. Kitchen toured, supply of food observed and food stored properly for perishable and nonperishable. Medications were stored in a locked cabinet in kitchen. Cleaning supplies were in a locked cabinet under the kitchen and in locked cabinet in garage. Smoke detectors were checked and operating. Carbon monoxide was not working. Facility has a pull station fire alarm. Fire extinguisher has a service date of 1/11/24. Resident, medication, and staff records were reviewed. R1's centrally stored log was reviewed and errors were observed. Amlodipine and Esomepradole were not logged on the centrally stored log. Morphine prescription showed quantity of 30 however it was crossed out and handwritten in quantity 52. PRN log shows 34 were given out of the 30 or 52 with 23 left. Morphine start date shows 03/4/24. LPA took photos. Staff did not have hospice training for residents on hospice. Hospice care plans did not meet regulation requirements. Deficiencies were observed and will be cited under Title 22, Division 6. See LIC 809D. Civil Penalty was issued. An exit interview was conducted with the Administrator. A copy of this report, plan of correction and appeal rights were discussed and left with the Administrator, Socorro Telmo, whose signature on this form confirms receipt of these documents.the state’s words, verbatim · CDSS document, May 23, 2024

The state marks this report as 24 pages; the online copy we transcribed has 7. You can request the full file from the county licensing office.

Type of visit: Case Management - Deficiencies

Licensing Program Analysts (LPA) Shawna Doucette and Lisa Salazar arrived at the facility unannounced to conduct a complaint investigation. During the course of the investigation LPA observed additional deficiencies. LPA met with Administrator Socorro Telmo. LPA interviewed staff. LPA reviewed records for R1 and R2. Facility is fire cleared for one bedridden resident in Room 5. Upon review of records, it was found R1 and R2 are both bedridden. R1 is in Room 1 and R2 is in Room 2. Neither room 1 or 2 are fire cleared Refer to 809d. Civil penalties issued for fire clearance. A copy of this report with plan of correction and appeal rights were provided.the state’s words, verbatim · CDSS document, Mar 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87202(a) · Plan of correction due date: Mar 15, 2024

87202 Fire Clearance (a) All facilities shall maintain a fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. Prior to accepting or retaining any of the following types of persons, the applicant or licensee shall notify the licensing agency and obtain an appropriate fire clearance approved by the city, county, or city and county fire department, or district providing fire protection services, or the State Fire Marshal. This requirement was not met as evidenced by: Licensee has 2 out of 5 residents bedridden and is only fire cleared for one resident in room 5. R1 is in room 1 and R2 is in room 2 which are not fire cleared rooms which poses and immediate health safety and or personal rights risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2024

Plan of correction: Plan of Correction POC Licensee agrees to submit LIC200, LIC 9054, facility sketch and 610D by POC due date 03/15/24. Civil Penalties issued.

Type of visit: Case Management - Deficiencies

On 03/14/24, Licensing Program Analysts (LPA) L. Salazar and S. Doucette arrived at the facility unannounced to conduct a 10 day visit. LPAs were greeted by caregiver and were allowed entry into the facility. Administrator arrived to the facility shortly after. LPAs toured the facility and observed 5 residents in care. 1 out of the 5 residents was observed in a hospital bed with full bed rails. A physician's order to admit R1 on Hospice care was observed, however, no Dr's signature is observed on the order and no Hospice care plan was in file. R1 was observed to have 2 unstageable pressure injuries on each heel. Resident R2 was observed in a hospital bed with half bed rails. Administrator stated R2 was on Hospice, however, no hospice care plan was observed on file. LPA observed a paper from Traditions Health admitting R2 to Hospice, however, there is no doctor signature on the order. LPAs observed residents in care to have dementia. LPAs observed 2 hours of dementia training in file for Staff S1. Based on today’s visit, deficiencies are being cited, per California Code of Regulations, Title 22, Division 6, Chapter 8 on the attached 809D. An exit interview was conducted with Administrator. A copy of this report and appeal rights were discussed and provided at the time of visit. A plan of correction was developed and reviewed by Administrator with a POC date of 03/15/24.the state’s words, verbatim · CDSS document, Mar 14, 2024

From the deficiency page — Deficiency type: Type A · Section cited: CCR 87633(a)(4) · Plan of correction due date: Mar 15, 2024

87633 Hospice Care of Terminally Ill Residents (a) The licensee shall be permitted to accept or retain residents who have been diagnosed as terminally ill by his or her physician...who may or may not have restrictive and/or prohibited health conditions, to reside in the facility and receive hospice services from a hospice agency in the facility when all of the following conditions are met: (4) A written hospice care plan which specifies the care, services, and necessary medical intervention related to the terminal illness as necessary to supplement the care and supervision provided by the facility is developed for each terminally ill resident or prospective resident by that resident’s hospice agency and agreed to by the licensee and the resident, or prospective resident, or the resident’s or prospective resident’s Health Care Surrogate Decision Maker, if any, prior to the initiation of hospice services in the facility for that resident, and all hospice care plans are fully implemented by the licensee and by the hospice(s). This requirement was not met as evidenced by LPAs records review and interview with Administrator. There are no hospice care plans in resident files. If not corrected, this poses an immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2024

Plan of correction: Administrator will submit Hospice Care plan for Resident R1 by POC date of 03/15/24. Hospice agency deliverd the hospice care plan for R2 during LPAs visit.

From the deficiency page — Deficiency type: Type A · Section cited: CCR87608(a)(5)(B) · Plan of correction due date: Mar 15, 2024

87608 Postural Supports (a) Based on the individual's preadmission appraisal, and subsequent changes to that appraisal, the facility shall provide assistance and care for the resident in those activities of daily living which the resident is unable to do for himself/herself Postural supports may be used under the following conditions. (5) Under no circumstances shall postural supports include ...(B) Bed rails that extend the entire length of the bed are prohibited except for residents who are currently receiving hospice care and have a hospice care plan that specifies the need for full bed rails. This requirement was not as evidenced by LPAs observation of records. There is no order in Resident R1's file for full bed rails. If not corrected, this poses an immediate Health and Safety risk to residents in care.the state’s words, verbatim · CDSS document, Mar 14, 2024

Plan of correction: Administrator will submit Hospice Care plans for Resident R1 that includes order for full bed rails. Resident R2 by POC date of 03/15/14.

The state marks this report as 3 pages; the online copy we transcribed has 2. You can request the full file from the county licensing office.